Coronavirus disease 2019 (COVID-19) is associated with a high rate of
thrombosis. Prolonged activated partial
thromboplastin times (aPTT) and
antiphospholipid antibodies (aPL) are reported in
COVID-19 patients. The majority of publications have not reported whether patients develop clinically relevant persistent aPL, and the clinical significance of new aPL-positivity in
COVID-19 is currently unknown. However, the reports of aPL-positivity in
COVID-19 raised the question whether common mechanisms exist in the pathogenesis of
COVID-19 and
antiphospholipid syndrome (APS). In both conditions,
thrombotic microangiopathy resulting in microvascular injury and
thrombosis is hypothesized to occur through multiple pathways, including endothelial damage, complement activation, and release of neutrophil extracellular traps (NETosis). APS-ACTION, an international APS research network, created a
COVID-19 working group that reviewed common mechanisms, positive aPL tests in
COVID-19 patients, and implications of
COVID-19 infection for patients with known aPL positivity or APS, with the goals of proposing guidance for clinical management and monitoring of aPL-positive
COVID-19 patients. This guidance also serves as a call and focus for clinical and basic scientific research.